LogistiCare FAIL: It's Not Just Wisconsin

On July 11, 2012, when we published a story about the failure of state transportation broker LogistiCare to provide rides which appears to have contributed to the death of a Waupaca Man in need of regular dialysis, we knew from research that failure to provide services was not unique to Wisconsin.

Increasingly, it appears that the business model LogistiCare uses across the nation may be based on the premise that denying services to qualified people boosts its earnings -- even when failure to do so has life-or-death implications.  Here's a report from Cheasapeake, VA:

In the Waupaca case, after missing at least 7 rides to dialysis appointments, 67 year-old Jim Barry told Waupaca County Post/Waupaca NOW:

"I feel like they’re trying to kill me.  Yesterday, I made my funeral arrangements."

Mr. Barry, unfortunately, is no longer with us, indicating a massive failure on the part of LogistiCare -- problems that are being repeated across the nation.  WVEC reports:

Rose Whybark of Chesapeake has had to find out the answer to that question more times than she wants. Her 17-year-old son, Gary, relies on Logisticare to get to and from his appointments. He has cerebral palsy and scoliosis that recently required back surgery. He has to be transported on a stretcher. Whybark says Gary often misses appointments because the transportation provider shows up late or not at all.

"His doctor appointments are important because we have to get weighed, plus blood work, because he has seizures. I have problems with everything with Logisticare at least six to eight times a year, and I feel that's a lot when your child goes to the doctor every three months," said Whybark.

Vicki Gilikin of Newport News has the same complaint. The Medicaid patient says her illnesses sometimes require as many as five doctors' appointments a week. 

The report goes on to explain how repeated and consistent service failure results in this client having to seek medical attention at a hospital emergency.  Perhaps this helps LogistiCare keep more of the more than 6 million dollars a month that the state of Virginia pays this private organization, but at what cost in terms of additional health care, human suffering, and even loss of life?

Milwaukee Journal Sentinel reported in August 2011, just 5 weeks into into LogistiCare's 3-year contract to provide Non Emergency Medical Transportation (NEMT) similar results in Wisconsin -- no-show rides, patients are arriving late to appointments, siblings aren't being permitted to ride together, and the company's mechanism for working with transportation providers is chaotic

Joe Sanfelippo, leasing manager for American United Taxi Cab of Milwaukee, states:

After nearly three weeks of trying to do business with LogistiCare, we gave up and refuse to accept rides from their company,". "They would email or fax a list of rides and, a couple of hours later, call and say not to do them. The next day at 9 or 10 in the morning, we'd get a list of rides for people with 8 a.m. appointments.

In Madison, Badger Cab. the only transportation company in Dane County to sign a contract with Logisticare, experienced even worse problems.  After just one day of the bureacratic nightmare and endless customer service hold-times, this provider stopped accepting rides brokered by LogistiCare.  Kurt Schneider, spokesman for Badger Cab explained: 

[the company is] severing its relationship [with Logisticare because of ] numerous issues, including customer phone numbers and addresses provided by Logisticare that were riddled with errors and communications problems so serious that at one point on a chaotic Friday, according to accounts representative , four or five of his dispatchers could not take regular calls because they were trying to iron out problems with Logisticare customers.

Both Wisconsin newspapers identify a dysfunctional customer service system as a major part of the problem -- while LogistiCare claims that "99 percent" of the rides they broker are "complaint free", this proclaimation does not pass the smell test and appears to be the misleading results of a complaint process that prevents people from expressing concerns, much less provide resolution to transportation problems that, as Waupaca County learned, can literally kill.

WVEC 13 News Troubleshooters reports that in 2011 through March of 2012:

Logisticare transportation providers in the Hampton Roads region received 15,415 complaints for being tardy. 1,736 were for "no shows."

Logisticare's headquarters in Atlanta also gets an "F" rating from the Better Business Bureau; although, the Norfolk branch gets a "B."

LogistiCare reports that because they broker about 4 million rides per year in Virginia, so the problems being reported are statistically insignificant.  Craig Marva of the Virginia Department of Medical Assistance Services, the agency that contracts with Logisticare states:

We do not know of any other state that requires a higher percentage of complaint-free trips. Although 99% of those trips are complaint-free, due to the overall volume and complexity of trips, there will still be errors and complaints and that is where both LogistiCare and the DMAS transportation staff focus our resources.

The last sentence above is curious, because in Dane and Milwaukee Counties, service providers can verify that LogistiCare's procedures and cumbersome requirements are responsible for service failures -- problems so sever that Badger Cab in Madison withdrew participation after 1 day and in Milwaukee, United Taxi Cab tried to work out problems with LogistiCare for nearly 3-weeks before giving up.

A County Transportation Director that has stepped forward to write reports for upcoming issues of VOICES Newspaper (starting in August), can document that typical hold-times when trying to contact LogistiCare are extremely long -- it is not unusual to spend an hour or more on hold!

The process that LogistiCare has implemented to document complaints/problems does not work and denies legally mandated fair hearings as required by law.  When brought to LogistiCare's attention, they claimed that they would change procedures -- this transportation manager (who's identity we will protect until we publish his/her reports) has found that no real changes have taken place and continues to document outrageous hold times and endless run-arounds which some might even find comical if we weren't talking about life-or-death situations.

And even though LogistiCare itself has admitted that complaint procedures that were initially part of the contracted agreement with Wisconsin were inadequate, resulting in company announcements that they would change the process to be more responsive, in fact, LogistiCare has undermined any changes.

THIS announcement by ForwardHealth, (July 2012) announces the expansion of LogistiCare's operating territory to include HMO enrollees in Milwaukee, Waukesha, Washington, Ozaukee, Kenosha, and Racine Counties and identifies the same dysfunctional complaint process that LogistiCare announced it would change.

Is this a stealth attempt to undermine open, timely, and meaningful changes in the complaint process?

The Centers for Medicare & Medicaid Services outlines its expectations for complaints, appeals for denied services, and grievances. 

The appeals and grievance process LogistiCare launched in Wisconsin and now appears to be reinstating by fiat with its latest service expansion appears to violate the letter and spirit of applicable federal mandates.

At-best, LogistiCare is demonstrating that they are incapable of monitoring themselves -- claims that they provide 99 percent of brokered rides without complaint are meaningless and even deceitful if they have structured their business model to prevent complaints.

A group of concerned Wisconsin professional, people with the greatest expertise and direct experience at the issues underlying these issues, have sent a letter (.pdf) to the Joint Legislative Audit Committee, Co-Chairs Sen. Cowles and Rep Kerkman, Senators Lazick, Darling, Vinehout, Lassa; Representatives Peterson, Vos, Jorgensen, and Richards.  They are demanding a full program audit of LogistiCare.

The disturbing report from WVEC 13 News in Virginia confirms the need to:

• Ensure Medicaid members have reasonable and timely access to transportation to Medicaid-covered services and document those that are denies seizes or have rides set up that are unreasonably late or don't show up at all.
• Evaluate whether transportation services for Medicaid members use the most-economical mode of transportation available
• Verify that fraud, waste, and abuse do not occur -- without a third-party monitoring this situation, it is not reasonable to expect potential problems in these areas to be fully-monitored
• Reduce Medicaid expenditures while providing mandated services -- there is evidence to suggest that Medicaid and other state transportation aides are paying higher costs for individual rides than the exact same transportation services provided prior to contracting NEMT to private brokerage organization
• More-fully compile and assess all data related to NEMT and related transportation services being provided so that every opportunity to seek reimbursements and other monies from available funding sources is explored and utilized.

At the heart of the problem appears to be a serious conflict of interest.  Milwaukee Journal Sentinel reports that the 3-year contract with Wisconsin pays the company approximately $33 million per year while saving the state about $2.5 million, though there are reports that this figure is actually closer to $40 million.

The company gets its revenue from a flat rate applied to ALL people that  may be qualified for brokered transportation services.  If people do not use that service, for whatever reason (no need, no show, etc...) LogistiCare gets to pocket that money.

It is wrong to privatize health care services to Wisconsin's neediest citizens in a manner that allow out-of-state corporate conglomerates to increase their profits by flatly denying services for any reason and it is patently offensive (and perhaps criminal) if rides are routinely being denied because the appeal/grievance process is designed to discourage, prevent, and hide problems.

If there are misunderstandings in this process, LogistiCare is responsible for them.  lease contact your state representatives and demand an operational audit of LogistiCare.

Failure to get people to health care appointments in a timely manner does not save anyone a dime and literally kills.  Unfortunately, it appears denying these rides may increase profits for this state contractor.